Introduction

In every year since 2014, more than 2,000 applicants have sought placement in veterinary internship and residency positions through the VIRMP. Placement in positions listed with the VIRMP is competitive. In 2019, for example, 2,168 applicants applied for 1,889 positions offered by 820 programs, with 63% of applicants securing positions.¹

The VIRMP provides a common application for internship and residency positions. Applicants must provide a personal statement or cover letter, a curriculum vitae or resume, their veterinary class rank, their GPA, and letters of reference. The application is then made available to the programs selected by the applicant. The process for evaluating applicants is dictated by each program and, thus, is variable and largely unknown. In 2005, a survey was conducted to characterize the selection criteria for veterinary interns.² Respondents ranked 6 criteria from most important (a score of 1) to least important (a score of 6). The overall order of importance for the application materials in determining selection was letters of reference (mean score, 1.4), class rank (2.7), curriculum vitae (3.1), GPA (3.2), personal statement (3.4), and transcripts (3.8).

The survey² also identified criteria that led reviewers to remove a candidate from consideration. Respondents indicated that a letter of reference reflecting an average or below average applicant, lack of a letter of reference from a diplomate of the relevant specialty, GPA < 2.91, and lack of experience in the relevant specialty would negatively impact an applicant's application.² However, a similar assessment of veterinary resident applications is not available.

In recent years, a greater emphasis has been placed on student well-being in the veterinary medical profession.^3,4,5,6 One of the most common stressors for veterinary students is anxiety surrounding academic performance and competition with peers.^5,6 In 1 survey,⁴ a third of students cited competition as a key contributor to anxiety. Students serving on the Health and Wellbeing Task Force in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University similarly identified academic competition as a stressor. Specifically, these students, in addition to those providing feedback through open forums and surveys, indicated that class ranking contributes remarkably to academic stress on the basis of a perception that class rank determines opportunities for internships and residencies after graduation. Colorado State University students conveyed the belief that candidates must be in the top 5% to 10% of their class to be competitive. This is contrary to the previous study² that found a GPA < 2.91 was restrictive but not an exclusion.² Additionally, this belief is inconsistent with 1 author's (LVK) 10 years of experience in selecting residents for the comparative medicine training program at Colorado State University. Applicants selected for that residency have had a mean class rank of 45 (normalized to a class size of 116), performing in the top 38% of their class.

Given the lack of knowledge regarding the role of class rank in intern and resident selection and the negative impact of class ranking on veterinary student well-being, we aimed to characterize how class rank and other criteria are used by programs to evaluate VIRMP applicants. Our hope was that these data would provide students an understanding of key considerations in the selection process. Further, we hoped to stimulate dialogue regarding the risks and benefits of using class rank in intern and resident selection.

Materials and Methods

A survey designed to be distributed to program directors for internship and residency programs was created with standard software.^a For the survey, participants were provided a list of 7 items (cover letter, letters of reference, curriculum vitae or resume, veterinary class rank, overall GPA, grades for classes specifically related to the internship or residency specialty area [ie, specialty grades], and interview) they could potentially use in evaluating applicants for an internship or residency and asked to indicate how important each item was in their assessment on a scale from 0 (not important at all) to 5 (most important). They were then asked to rank those 7 items, along with an open item asking participants to list other criteria they used, from most important (1) to least important (8). Participants were also asked whether they used class rank or GPA as a cutoff for candidate consideration and, if so, what cutoff they used and how the cutoff was determined. Finally, participants were asked how coming from a veterinary program that did not provide class rank or that did not provide a GPA would affect their evaluation of a candidate, whether they used class rank as a means to compare applicants from different veterinary colleges, and whether they had any additional comments. The survey was reviewed and approved by the Colorado State University Institutional Review Board.

A message containing a link to the survey was emailed to the program directors for all academic and nonacademic internship and residency programs in all specialties listed on the VIRMP site in 2018. In addition, the survey link was emailed to the 45 program directors for the American College of Veterinary Pathologists, which does not participate in the VIRMP. A total of 572 surveys were distributed in September 2018, and the survey was open until December 30, 2018.

At the close of the survey, data were exported to a spreadsheet program^b for analysis. Surveys that were not 100% complete as identified by the survey software were eliminated from the data set. Survey responses were reviewed to ensure there were not multiple responses from an institution for any individual program. They were also reviewed to identify whether a program director who oversaw multiple programs responded for each program. This was done by sorting responses for questions and looking for redundant answers from the same institution for multiple programs. For any program that provided both internship and residency positions and indicated that they used identical criteria for assessing these 2 candidate cohorts, the information was duplicated. That is, if a respondent who oversaw an internship program reported that they also oversaw a residency program, the data were duplicated and relabeled as responses for a residency program. Specialties for which > 10 responses were received were analyzed individually. Responses to the open-ended question asking for additional comments were reviewed and categorized on the basis of common themes.

Results

The survey link was sent to program directors for 572 internship and residency programs. Responses were received for 159 internship, 185 residency, and 83 unidentified programs. However, data for 17 internship, 14 residency, and 83 unidentified programs were removed because surveys were incomplete. Data for the remaining 142 internships and 171 residency programs were analyzed. There were no institutions that provided multiple responses for the same internship or residency program. There were no repetitive responses to questions to suggest a single program director oversaw multiple programs. There were 53 internship and 51 residency programs that identified identical selection criteria for their internship and residency programs, and their data were duplicated for analysis. Following duplication of dual programs, there was a total of 195 internship and 222 residency programs in the final analysis. Of the 195 internship programs, 93 (47.7%) were classified as academic and 98 (50.3%) were classified as nonacademic. There were 4 internships that could not be classified. Of the 222 residency programs, 155 (69.8%) were classified as academic and 66 (29.7%) were classified as nonacademic. There was 1 residency program that could not be classified. The 195 internship programs represented 26 specialty areas (Table 1), and the 222 residency programs represented 29 specialty areas.

For both internship programs and residency programs, mean importance scores assigned to the 7 listed items that respondents could use to assess candidates resulted in the same ordering of the items from most to least important (letters of reference, interview, curriculum vitae or resume, cover letter, overall GPA, veterinary class rank, and specialty grades; Figure 1). For all programs combined, mean importance score was 4.60 for a candidate's letters of reference (possible scores ranged from 0 [not important at all] to 5 [most important]), 4.18 for the candidate interview, 3.85 for the candidate's curriculum vitae or resume, 3.49 for the candidate's cover letter, 3.06 for the candidate's overall GPA, 2.77 for the candidate's class rank, and 2.66 for the candidate's grades in classes related to the specialty (ie, specialty grades).

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Importance scores assigned on a scale of 0 (not important) to 5 (most important) by directors of veterinary internship (n = 195) and residency (222) programs who responded to a survey developed to characterize the criteria used to evaluate applicants for internship and residency positions; the 7 items were cover letter, letters of reference, curriculum vitae or resume, veterinary class rank, overall GPA, grades for classes specifically related to the internship or residency specialty area (specialty grades), and interview.

Citation: Journal of the American Veterinary Medical Association 258, 7; 10.2460/javma.258.7.776

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Other criteria respondents indicated they used to evaluate internship candidates included research experience, publications, previous experience or interest in the specialty, communication skills, and references from individuals not listed by the candidate. Other criteria respondents indicated they used to evaluate residency candidates included research experience, publications, interest in the specialty, personal character traits, and references from individuals not listed by the candidate.

Rankings of the importance of the 7 items, along with an “other” item, were similar for internship and residency programs (Figure 2). For both internship and residency programs, the most important item was a candidate's letters of reference, followed by the interview. Respondents for internship programs placed more importance on the candidate's cover letter, compared with their curriculum vitae or resume, whereas respondents for residency programs placed more emphasis on the candidate's curriculum vitae or resume. Respondents for internship programs assigned an equal importance to overall GPA and class rank, whereas respondents for residency programs assigned slightly more importance to class rank than to overall GPA. There were no differences in ranking between academic and nonacademic programs.

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Rankings assigned by respondents to the survey described in Figure 1 for the 7 items, along with an open item for other criteria they used (“other”), from most important (1) to least important (8).

Citation: Journal of the American Veterinary Medical Association 258, 7; 10.2460/javma.258.7.776

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For 42 of the 195 (21.5%) internship programs and 44 of the 222 (19.8%) residency programs, respondents indicated they used class rank as a cutoff for candidate consideration. Of the 42 internship programs that considered class rank for disqualification of candidates, 10 (23.8%) indicated they considered only candidates in the top 25% of their class, 20 (47.6%) indicated they considered only candidates in the top 50% of their class, 4 (9.5%) indicated they considered only candidates in the top 75% of their class, and 8 (19.1%) indicated they used some other class rank cutoff. Of the 44 residency programs that considered class rank for disqualification of candidates, 11 (25%) indicated they considered only candidates in the top 25% of their class, 24 (54.5%) indicated they considered only candidates in the top 50% of their class, 1 (2.3%) indicated they considered only candidates in the top 75% of their class, and 8 (18.2%) indicated they used some other class rank cutoff.

Similarly, for 64 of the 195 (32.8%) internship programs and 79 of the 222 (35.6%) residency programs, respondents indicated they used overall GPA as a cutoff for candidate consideration. Of the 64 internship programs that considered overall GPA for disqualification of candidates, 26 (40.6%) indicated they considered only candidates with a GPA ≥ 3.0, 18 (28.1%) indicated they considered only candidates with a GPA ≥ 3.3, 13 (20.3%) indicated they considered only candidates with a GPA ≥ 3.5, and 7 (10.9%) indicated they used some other GPA cutoff. Of the 79 residency programs that considered overall GPA for disqualification of candidates, 35 (44.3%) indicated they considered only candidates with a GPA ≥ 3.0, 23 (29.1%) indicated they considered only candidates with a GPA ≥ 3.3, 15 (19.0%) indicated they considered only candidates with a GPA ≥ 3.5, and 6 (7.6%) indicated they used some other GPA cutoff.

Respondents for 74 of the 195 (37.9%) internship programs and 88 of the 222 (39.6%) residency programs indicated that a lack of a class ranking would negatively impact or somewhat negatively impact their assessment of a candidate's application. Similarly, respondents for 112 of the 195 (57.4%) internship programs and 120 of the 222 (54.1%) residency programs indicated that a lack of an overall GPA would negatively impact or somewhat negatively impact their assessment of a candidate's application.

Respondents for 62 of the 195 (31.8%) internship programs and 66 of the 222 (29.7%) residency programs indicated they used class rank to compare applicants from different veterinary colleges. In contrast, respondents for 133 of the 195 (68.2%) internship programs and 156 of the 222 (70.3%) residency programs indicated that class rank may not or does not provide a means to compare applicants from different veterinary colleges.

Respondents from 59 internship and 72 residency programs provided additional information on their perceptions of overall GPA and class rank. Respondents stated that overall GPA and class rank were used to determine academic achievement and that class rank was particularly useful in assessing candidates from colleges that did not report an overall GPA. Comments on grade inflation were common, with class rank considered to provide a means to help differentiate applicants. Other respondents stated that class rank was a poor measure of success and that overall GPA and class rank were not as important as a candidate's skills or attitude.

Responses were received for 61 small animal medicine and surgery, 20 small animal surgery, and 14 emergency and critical care internship programs and for 27 laboratory animal medicine, 25 small animal medicine and surgery, 22 small animal medicine, 21 small animal surgery, 21 pathology or clinical pathology, 15 emergency and critical care, 14 diagnostic imaging and radiology, and 11 neurology residency programs. For these 3 internship and 8 residency specialties, importance scores assigned to the 7 listed items that respondents could use to assess candidates were summarized (Figures 3 and 4), along with rankings for those 7 items and an “other” item (Figures 5 and 6). The candidate's letters of reference, the candidate interview, and the candidate's curriculum vitae or resume were the 3 most important criteria for all these internship and residency specialties. Most of these internship and residency specialties did not use a minimum class rank or overall GPA for candidate selection (Tables 2 and 3). Of those programs that did, most used a class rank cutoff of ≥ 50% and an overall GPA cutoff of ≥ 3.0.

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Importance scores assigned on a scale of 0 (not important) to 5 (most important) by directors of small animal medicine and surgery (n = 61), small animal surgery (20), and emergency and critical care (14) internship programs who responded to the survey described in Figure 1.

Citation: Journal of the American Veterinary Medical Association 258, 7; 10.2460/javma.258.7.776

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Importance scores assigned on a scale of 0 (not important) to 5 (most important) by directors of laboratory animal medicine (n = 27; LAM), small animal medicine and surgery (25; SAMS), small animal medicine (22; SAM), pathology or clinical pathology (21; PATH), small animal surgery (21; SAS), emergency and critical care (15; ECC), diagnostic imaging and radiology (14; DIR), and neurology (11; NEURO) residency programs who responded to the survey described in Figure 1.

Citation: Journal of the American Veterinary Medical Association 258, 7; 10.2460/javma.258.7.776

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Rankings for the 7 items, along with an open item for other criteria they used (“other”), from most important (1) to least important (8), assigned by directors of veterinary small animal medicine and surgery (n = 61), small animal surgery (20), and emergency and critical care (14) internship programs described in Figure 2.

Citation: Journal of the American Veterinary Medical Association 258, 7; 10.2460/javma.258.7.776

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Rankings for the 7 items, along with an open item for other criteria they used (“other”), from most important (1) to least important (8), assigned by directors of veterinary laboratory animal medicine (n = 27; LAM), small animal medicine and surgery (25; SAMS), small animal medicine (22; SAM), pathology or clinical pathology (21; PATH), small animal surgery (21; SAS), emergency and critical care (15; ECC), diagnostic imaging and radiology (14; DIR), and neurology (11; NEURO) residency programs described in Figure 2.

Citation: Journal of the American Veterinary Medical Association 258, 7; 10.2460/javma.258.7.776

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Discussion

Results of the present study suggested that although most veterinary internship and residency programs consider class rank and overall GPA when evaluating candidates, these 2 items were not the most important. For both internship and residency programs, the most important items were a candidate's letters of reference, followed by the interview, cover letter, and curriculum vitae or resume.

Two previous surveys evaluated veterinary internship and residency selection criteria. A study⁷ of the American College of Veterinary Ophthalmologists selection process reflects the perceived value of subjective criteria in resident selection, including intelligence, ability to communicate, work ethic, and interpersonal skills. These subjective criteria are assessed through the cover letter and the letters of reference.⁷ Similarly, representatives from veterinary internship programs report that letters of reference are one of the most important components of the application.² In that study, the cover letter, curriculum vitae, GPA, and class rank were weighted similarly in evaluating candidates for internship positions.

The findings in both of these studies that letters of reference were the most important component of the application for internship and residency positions were similar to findings of the present study, which identified letters of reference as the most important item. In the present study, we did not ask respondents to identify the value they assigned to the author of the letters of reference (eg, a diplomate vs someone who was not a diplomate). However, a previous American College of Veterinary Ophthalmologists study⁸ found that applicants who provided a letter of reference from a specialty college diplomate had higher success rates, compared with those who did not. In one author's (LVK) experience in reviewing applicants for the Colorado State University comparative medicine training program, letters of reference from diplomates of the American College of Laboratory Medicine were more favorably perceived.

After the letters of reference, we identified the candidate interview as the second most important item in assessing internship and residency candidates. Candidates’ curriculum vitae and cover letter were weighted similarly and assigned more value than overall GPA and class rank, which were also weighted similarly. Our findings may help give students a better understanding of how applicants are reviewed by internship and residency programs, which could assist students in strategizing their approach in obtaining a coveted position.

There is little published information regarding the evaluation and selection of applicants for residency programs in the veterinary profession, but several studies^{9,10,11,12,13,14,15} of the medical profession have been published. In general, 7 criteria were commonly used when evaluating applicants for medical residency positions: US Medical Licensing Examination step 1 score, medical school grades, rank in medical school, honors designations (specifically, designation by the Alpha Omega Alpha honor society), medical school reputation, letters of reference, and dean's letters. A 1993 survey⁹ of medical radiology program directors identified GPA and class rank as having the greatest importance among 20 criteria used to select residents; other top criteria included Alpha Omega Alpha honor society designation and letters of reference. Grades were more heavily weighted for academic positions versus positions in nonacademic practice. A survey¹⁰ of ophthalmology residencies from 2003 through 2008 identified Alpha Omega Alpha honor society designation, US Medical Licensing Examination score, and medical school reputation as predictors of successful residency matching. Similar findings were reported in a 2011 study¹¹ evaluating ophthalmology residency matching. In another study¹² conducted in 2002, individuals selecting orthopedic residents ranked 26 criteria, with the top 7 being the medical program of origin, US Medical Licensing Examination score, rank in medical school, interview, professional appearance, letters of reference, and Alpha Omega Alpha honor society designation. A 2016 review¹⁵ of orthopedic surgery resident selection identified 6 criteria as being of particular importance: US Medical Licensing Examination score, class rank, honors designation, dean's letter, letters of reference, and research experience. Finally, familiarity, typically established during a rotation through the department, has been identified as a particular advantage for candidates seeking a residency position.¹⁴

The likelihood that the selection process will reliably identify candidates who will thrive is of great interest to those who invest the time and resources in intern and resident training. Other than the ultimate outcome of becoming a board-certified specialist, there is little information in the veterinary literature that defines a successful outcome for residents. In the medical profession, it has been reported that grades, standardized examinations, interviews, and match ranking do not predict performance in pediatric medicine,¹⁶ obstetrics and gynecology,¹⁷ internal medicine,¹⁸ surgery,¹⁹ urology,²⁰ emergency medicine,²¹ or orthopedic^22,23 residencies. Successful residents, as identified by the program director after completion, typically had strong letters of references²⁰ and interviewed well.^13,24 Scores on the US Medical Licensing Examination did not strongly correlate with resident clinical performance but did correlate with successful completion of specialty examinations.^20,21,23

Results of the present study indicated that class rank is used in evaluating internship and residency program applications, and it seems likely that at least some programs that receive large numbers of applicants rely on class rank for initial stratification. Still, we question the value of class rank in characterizing applicant quality. Some respondents in the present study stated that class rank does not correlate with performance in the internship or residency, similar to the case for medical school residencies.²¹ Other respondents indicated that grade inflation is a concern. However, grade inflation (ie, receiving a higher grade for undeserving performance) is probably not as important as grade compression.^25,26 At Colorado State University, for example, the top-ranked student of a class of 147 and the first student in the second quartile had a difference in GPA of only 0.128 points. Given that veterinary schools recruit top academic performers, it's not surprising that class GPA is high.

We must also consider that students attribute considerable shame, anxiety, and competitiveness to the class ranking system. This adverse impact on well-being is widespread, affecting students who have no intention of seeking postgraduate training as well as those who feel compelled to maintain a high class rank just in case they wish to do so. Veterinary student health and well-being has become an important concern in recent years, and academic rigor and competitiveness have been identified as key stressors for veterinary students.^4,5,6 The academic rigor associated with a professional program cannot be eliminated; however, the extent to which institutions promote, intentionally or not, competitiveness among students can be modified.

At Colorado State University, class rank has been identified as a factor that promotes competition, anxiety, and diminished self-worth. Findings of the present study suggested that class rank is used in the internship and residency selection process but is considered less important than other criteria. We respectfully submit that elimination of class ranking would improve veterinary student well-being without an insurmountable negative impact on internship and residency selection.